Tailored treatment of female indirect inguinal hernias by using single-port laparoscopic percutaneous internal ring suture: a comparison between children and adults.

PURPOSE: To compare the outcome of indirect inguinal hernias repaired by using single-port laparoscopic percutaneous internal ring suture (SPIRS) between the pediatric and adult females. METHODS: The medical records of females who were clinically assessed to have inguinal hernia from Oct. 2016 to May 2022 were reviewed. Patients who received laparoscopy for the diagnosis of the hernia type and customized treatment according to their hernia type were included, while those who chose other operation methods initially were excluded. The patients were divided into the adult and pediatric groups based on their age. The demographic characteristics, hernia types, operation durations, and outcomes were analyzed between these two groups. RESULTS: A total of 65 adults and 60 children were included in this study. The median age was 38 years. (range: 23-88) for group A and 3 years (range: 0.1-16) for group P. Indirect hernias were present in 85% of adults and 100% of children. All the indirect hernias were repaired by SPIRS uneventfully. Incidence of contralateral patent processus vaginalis was 24% in adults and 50% in children (p = 0.016). The average operation time was 22/46 min (one/two sides) for the adults and 9/15 min (one/two sides) for the pediatrics (p < 0.010 for both). The overall complication rates were 5.4% and 3.3% for the adult and pediatric group respectively (p = 0.106). No recurrence was observed in the pediatric group, but two adults experienced recurrence and another had chronic postoperative inguinal pain, necessitating reoperation. The mean follow-up period was 38.6 ± 15.4 months for adults and 42.8 ± 18.9 months for children (p = 0.198). CONCLUSION: Our results support that the pathogenesis of indirect inguinal hernia for the female adults is due to the non-obliteration of a congenital processus vaginalis. Tailored treatment of the female IIH by using single-port laparoscopic percutaneous internal ring suture may be an alternative for the management of female IHs.

Quantitative electron microscopic analysis of postnatal development of zinc-positive nerve endings in the rat amygdala using Timm's sulphide silver technique.

The distribution and quantitation of zinc during postnatal development of the rat amygdala were investigated by light and electron microscopy with Timm's sulphide silver method. The adult rat amygdala could be divided into basolateral, basomedial, central, cortical, intercalated, lateral and medial subnuclei on the basis of Timm's plus Toluidine blue staining. Only a very weakly positive Timm's reaction could be observed in newborns, and a positive reaction was seen on the 5th postnatal day. The reaction became stronger with development, and reached adult levels by the 30th postnatal day. Electron microscopically, we investigated the basolateral subnucleus of the amygdala. The electron-dense deposits of silver grains from the Timm's reaction were only seen in nerve fibers endings containing many small clear vesicles. The results are similar to those described for mossy fiber endings in the rat hippocampus and in boutons of other telencephalic structures. The number of deposits of silver grains increased with age, and reached that of the adult between the 20th and 30th postnatal days. A significant increase in the number of silver grains per micron 2 area of the Timm's-positive nerve terminals occurred between the 10th and 20th postnatal days. Based on the available literature, these findings suggest that zinc exists in nerve fiber endings in the rat amygdala and that the amount increases with postnatal age. The findings are consistent with an important role for zinc in synaptic transmission.

Ultrastructure of monoaminergic terminals in the intermediolateral nucleus of the cat spinal cord.

Monoaminergic innervation of the intermediolateral nucleus of the cat spinal cord was investigated by fluorescence histochemistry and electron microscopy. Large numbers of monoaminergic terminals were labeled by prior administration of the false neurotransmitter 5-hydroxydopamine (5-OHDA). Ultrastructurally, 5-OHDA-labeled terminals fell into three types. Type I, which made up 55% of the labeled terminals, contained abundant, large and densely labeled vesicles and only a few small and unlabeled vesicles. This type was "bouton de passage". Type II, which made up 40% of the terminals, made asymmetrical synaptic contacts with typical postsynaptic structures. This type contained many small vesicles, some of which were labeled, and a few large dense-core vesicles. Type III, which made up 5% of the terminals, made close contact with presynaptic nerve endings containing abundant small unlabeled clear vesicles. The type III terminals contained many large and densely labeled vesicles and a few small flattened vesicles, most of which were unlabeled.